georgia Uninsured MOTORISTS COVERAGE
SELECTION/REJECTION
IL U 049 01 09 / © Insurance Services Office, Inc.,2008 / Page 1 of 5
Policy Number: / Policy Effective Date:
Company: / Producer:
Applicant/Named Insured:
IL U 049 01 09 / © Insurance Services Office, Inc.,2008 / Page 1 of 5
Georgia law permits you to make certain decisions regarding Uninsured Motorists Coverage. This document describes this coverage and the options available.
You should read this document carefully and contact us or your agent if you have any questions regarding Uninsured Motorists Coverage and your options with respect to this coverage.
This document includes general descriptions of coverage. However, no coverage is provided by this document. You should read your policy and review your Declarations Page(s) and/or Schedule(s) for complete information on the coverages you are provided.
Uninsured Motorists Coverage
Uninsured Motorists Coverage provides insurance protection to an insured for compensatory damages which the insured is legally entitled to recover from the owner or operator of an uninsured motor vehicle because of bodily injury or property damage caused by an automobile accident. Also included are damages due to bodily injuryorproperty damage that result from an automobile accident with a hit-and-run vehicle whose owner or operator cannot be identified.
Uninsured Motorists Coverage – Added On To At-Fault Liability Limitsprovides insurance protection, in general, with respect to an insured's covered losses that are in addition to the limits of liabilityunder any applicable bonds or policies.
Uninsured Motorists Coverage – Reduced By At-Fault Liability Limits provides insurance protection, in general, wherein the amount of coverage is reduced by all sums paid by or on behalf of anyone who is legally responsible.
Georgia law generally requires that your policy include Uninsured Motorists Coverage – Added On To At-Fault Liability Limits, unless you reject Uninsured Motorist Coverage entirely or unless youinstead select, for a reduced premium, Uninsured Motorists Coverage – Reduced By At-Fault Liability Limits.
Unless rejected, your policy must include Uninsured Motorists Coverageat limits not less than: (a) split limits of $25,000 for each person, subject to $50,000 for each accident with respect to bodily injury, and $25,000 for each accident with respect to property damage; or (b) a single limit of $75,000 for each accident. These limits will be referred to as the "minimum limits" for Uninsured Motorists Coverage.
Your options with respect to Uninsured Motorists Coverage include:
A.You mayselect Uninsured Motorists Coverage:
1.You may select Uninsured Motorists Coverage – Added On To At-Fault Liability Limits; or
2.You may reject Uninsured Motorists Coverage – Added On To At-Fault Liability Limits and select Uninsured Motorists Coverage – Reduced By At-Fault Liability Limits.
In addition, you may select Uninsured Motorists Coverage at limits equal to the liability coverage limits of your policy or, if the liability coverage limits of your policy exceed the above referenced "minimum limits" for Uninsured Motorists Coverage, you may select Uninsured Motorists Coverage at limits less than the liability coverage limits of your policy but not less than the above referenced "minimum limits" for Uninsured Motorists Coverage.
OR
B.You may reject Uninsured MotoristsCoverageentirely.
Please indicate your choice from either A. or B. as follows:
A.Selection Of Uninsured Motorists Coverage
Please indicate your choice by initialing next to the appropriate item(s) in Sections 1. AND 2.:
1.Selection of either Uninsured Motorists Coverage – AddedOn To At-Fault Liability Limits or Uninsured Motorists Coverage – Reduced By At-Fault Liability Limits
Please indicate your choice by initialing next to the appropriate item(s) in a. OR b.below:
(Initials) / a. / I select Uninsured Motorists Coverage – Added On To At-Fault Liability Limits.OR
(Initials) / b. / I reject Uninsured Motorists Coverage – AddedOn To At-Fault Liability Limits and select Uninsured Motorists Coverage – Reduced By At-Fault Liability Limits.
Signature Of Applicant/Named Insured / Date
2.Selection Of Uninsured Motorists Coverage Limits:
Please indicate your choice by initialing next to the appropriate item(s) in a. OR b. and signing below.
Please note that we only offer Uninsured Motorists Coverage limits up to the Liability Coverage limits of your policy, even though higher limits may appear below.
(Initials) / a. / I select Uninsured Motorists Coverage at limits equal to my Liability Coverage (Split Limits or Combined Single Limit).OR
(Initials) / b. / I select Bodily Injury Uninsured Motorists Coverage And Property Damage Uninsured Motorists Coverage at the following limit(s):
(Choose one Split Limits Bodily Injury option AND one Property Damage limit option OR one Combined Single Limit option from the following:)
(Initials) / Split Limits
Bodily Injury / (Initials) / Property
Damage / OR / (Initials) / Combined
Single Limit
$ / 25,000/50,000 / $ / 25,000 / $ / 75,000
50,000/100,000 / 50,000 / 100,000
100,000/200,000 / 100,000 / 200,000
100,000/300,000 / 150,000 / 250,000
250,000/500,000 / 200,000 / 300,000
300,000/300,000 / 250,000 / 350,000
500,000/500,000 / 300,000 / 500,000
500,000/1,000,000 / 500,000 / 1,000,000
1,000,000/1,000,000 / 750,000
1,000,000
(Other) / (Other) / (Other)
Signature Of Applicant/Named Insured / Date
B.Rejection Of Uninsured Motorists Coverage
If you wish to reject Uninsured Motorists Coverage entirely, you may do so by initialing and signing below.
(Initials)I reject Uninsured Motorists Coverageentirely.
Signature Of Applicant/Named Insured / Date
IL U 049 01 09 / © Insurance Services Office, Inc.,2008 / Page 1 of 5